Radiology: Development of Interventional Radiology
Guest: Dr. Philip Costello – Radiology, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Philip Costello, who is Professor and Chair of Radiology here at the Medical University of South Carolina. Dr. Costello, I want to talk about a term that many folks may not fully understand: interventional radiology. Years ago, all radiologists did was look at plane films. Now, they actually do procedures. Can you explain what interventional radiology is?
Dr. Philip Costello: Absolutely. It’s one of the most exciting fields of imaging and interventional procedure development over the last 20 years. And let me just explain how this field has evolved. As you indicated, perhaps 25 years ago, radiologists did perform and interpret x-ray studies. But, at that time, vascular procedures were being performed where a catheter would be placed into an artery or a vein, contrast material, dye, was injected, and x-ray pictures were taken. But this, by and large, was for the purpose, purely, of making a diagnosis.
As time evolved, the subspecialty of interventional radiology has developed into several fields. Let me start with the longest standing one, which is vascular interventional radiology. Through those catheters, that are either positioned through an artery or a venous structure, where dye was previously injected for a specific diagnostic test, now we can actually perform therapeutic procedures. How is this enabled? Well, everybody is familiar with the placement of coronary artery stents through catheters; through the coronary arteries, to open up blocked vessels. Well, obviously, the same procedures can be performed in any blocked vessel. It may be in the aorta. It may be in a kidney artery. It may be in a blood vessel to the leg or lower extremity. So, that is termed stenting, or vascular intervention; performing stents to unclog, or unblock, blood vessels in the body. This has led to tremendous interest because it doesn’t require an incision. This is performed through a small catheter.
Along with that, of course, we’ve developed larger procedures that can be performed to repair aneurysms; of the abdominal aorta, initially. And now, we’re able to perform repair of bulging vessels in the thorax. Aneurysm treatments, now, are largely going, so-called, noninvasive; noninvasive intravascular radiology. Again, this is usually a combined surgical-radiological approach, but very beneficial. A patient’s length of stay is reduced, and their overall mortality and morbidity features are also decreased. So, that’s one aspect of interventional radiology; the vascular part.
We can also treat tumors via catheters. For example, we can treat liver tumors via catheters, where we can actually inject radioactive chemotherapeutic agents into the tumor selectively. This is another field of interventional radiology that is being developed. We can also block off bleeding blood vessels. People involved in motor vehicle accidents, who have major trauma, may have a bleeding blood vessel that’s very difficult to stop. Opening a patient’s abdomen could be associated with high risk or a high mortality rate. We can place a catheter through the arteries, into the bleeding vessel, and block via a system of coils and embolic material. So, this is another aspect of interventional radiology that is being clearly defined into patient management on a daily basis.
Other areas of intervention involve the introduction of catheters into blocked bile ducts or blocked systems of the intestinal tract. And this, also, is performed by guidance and a direct visualization, utilizing a variety of tools and catheters, and even stents, to facilitate patient care in difficult, complex, medical management problems.
Another part of interventional radiology is interventional oncology. And this is a new and very exciting field, where we have developed, over the last ten years, ways of treating tumors not by radiation, but by heating or freezing techniques. These are called radiofrequency ablation and cryoablation. Via the skin, via a simple percutaneous technique, we can introduce into solid tumors in the liver or kidney heating or cooling probes that actually totally ablate small or even medium-sized tumors, offering, again, opportunities for prolonging life without the need for surgical intervention.
So, this gives you an idea of the exciting changes that have evolved from what started out as a diagnostic field into, now, mainstream therapeutic procedures; termed, loosely: interventional radiology.
Dr. Linda Austin: Wow. Now, if I were a potential patient listening to this, I would find it very exciting. Let’s imagine that I have an aneurysm and I come to the MUSC Emergency Room, who decides; and how is it decided, that I have an open surgical procedure, by a surgeon, or, let’s say, the placement of a stent by a vascular radiologist?
Dr. Philip Costello: Well, the fortunate thing, again, is that we, at MUSC, embody a team approach to patient management. So, what is best for the patient is decided by a team: by a vascular surgeon and a vascular radiologist. So, no one person would make that final decision. And, not, usually, would one person engage in a procedure. We feel that the best way to manage individual patients is through bringing the expertise and skills of surgeons and vascular radiologists together. So, that is, again, one of the great strengths of coming to MUSC. The team and the leadership that we have built into our programs, I think, are second to none.
Dr. Linda Austin: Dr. Costello, thank you so much for talking with us.
Dr. Philip Costello: Thank you very much.
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